Effects of Breathing Retraining Exercises in Pregnant Females With Postural Orthostatic Tachycardia Syndrome.

Postural orthostatic tachycardia POTS is characterized by excessive increase in heart rate when moving from lying to standing position, often accompanied by symptoms such as dizziness, fatigue, brain fog, lightheadedness, rapid heartbeat and palpitation.it most commonly effects the females of reproductive age and can be triggered by events like viral infections, trauma and hormonal changes. During pregnancy females may experience worsening of symptoms in first trimester due to hormonal changes and decreased blood volume later on in second and third trimester the blood volume begins to increase. However, breathing exercises helps to regulate the nervous system, improves parasympathetic activity and reduce sympathetic activity.

The study will be randomized clinical trial and will be conducted at Bashir hospital Sialkot and Fatima hospital Sialkot. The study will be completed in 10 months of duration after the approval of synopsis. Non probability convenience sampling will be used and 44 participants will be included in the study after randomization. The subjects will be divided into two groups. Group A (experimental group) will receive diaphragmatic breathing exercises whereas Group B (control group) will receive educational retraining whereas both groups will receive baseline treatments which includes progressive muscle relaxation techniques. The tools used for the study will be Vanderbilt orthostatic symptom score VOSS to evaluate orthostatic intolerance, blood pressure will be measured using non-invasive blood pressure measurement and pulse oximetry will be used to access the heart rate. After data completion data will be analyzed by using SPSS version 21.

Inclusion criteria

• • Pregnant female between the age of 19 to 35 years.

• Active standing results in a sustained increase in heart rate (HR) of at least 30 bpm or ≥120 bpm.
• POTS patients with a subacute onset of lightheadedness, dizziness, and presyncope provoked by standing.
• palpitations with chest discomfort, breathing difficulties, or feeling faint

Exclusion criteria

• • Uncontrolled hypertension/pre-eclampsia

• cardiovascular disorder
• Patients with uncontrolled diabetes
• Patient with Anemia, severe heart failure and neurodegenerative diseases.
• Females with the history of deep venous thrombosis.